Beacon of Health


Graham Cooper looks at how community hospitals are providing the local motor to promote prevention rather than cure within a philosophy of well-being. Community of Intellect Building Health in the Community HD Magazine March 2004

Forecasts of an obesity epidemic which resulted in ministers encouraging people to take much more personal responsibility for their health, spotlights the patient's illness in context with their daily lives. For thegeneral public the restrictive practice of medicine and its monopoly on illness has historically formed barriers to understanding, resulting in a dependency culture. The emphasis on curing illness undermines the healthsector¹s capacity to engage in the wellness of the community at large. What kind of healthcare infrastructure will support both a preventive and curative ethos, whilst opening the door to knowledge for a disengaged populace?

Pivotal to the process are primary care trusts, which manage 75% of the total health budget and are the major funders for the NHS. Family clinicians may be over-stretched but there are an increasing number who are attempting to address this conundrum. In Devon the chairman of the NHS Alliance Dr Michael Dixon is concerned with how best to use finite resources more effectively, believing that the role of the health system is to assist people in their own health. Whilst concerned with defining nation-wide targets, the NHS Alliance is also working closely with the Prince's Foundation for Integrated Medicine and is supporting the use of both orthodox and complementary care. As in the classical Greek tradition Dixon sees the doctor as an educator, in a closer relationship with the community. Adopting this position would mark a philosophical shift in the future delivery of healthcare from reactive to proactive. In his thoroughly researched book "Health Defences" 1 nutritional scientist Dr Paul Clayton describes the NHS as "really an illness service" costing each of us £750 a year. Rather than just treating sickness we should also be focusing on maintaining wellness discovering the root cause rather than trying to cure the symptoms Largely due to better public health and control of infectious diseases life expectancy since 1900 has nearly doubled (although the diabetic time bomb appears set to reverse this trend). Today, according to Dr Clayton, very few people actually die of old age, perhaps as little as one in 10,000. In fact, "most are finished off before 80" despite evidence which suggests our maximum life span is approaching 120 years. The object here is to explore significant and creative programmes that redress the balance between the care of the sick and increased patient involvement in their own health. Two pioneering icons in the spirit of the modern idiom clearly demonstrate how such a social-technical intervention may influence the form of community healthcare settings in the future.

Following common welfare concerns expressed by their patients, in 1926 two doctors George Scott Williams and Innes Pearce began a pilot project 2 in an ordinary house in the south London suburb of Peckham. The aim of the centre was to embody a broader health provision for the whole of the family unit, with the involvement of the community as central to a healthy life. One shocking discovery was how pervasive ill health was in the comfortable suburb. In 1935 the husband and wife doctors opened the remarkable Peckham Pioneer Health Centre designed by the structural engineer Sir William Owen. Nearly 1,000 families paid a shilling a week to take part in exercise and relaxation in the club-like atmosphere of the Peckham Experiment. To foster an informal communal setting as a contribution to well-being they planned a versatile universal built form where all parts were adaptable including the roof where exercise classes were held. To facilitate both observation and spontaneous social interaction the post and beam structural grid was arranged to provide sight lines and movement across the open planned space. The internal partitions were kept to a minimum and sliding windows maximised member's access to daylight and fresh air. At the heart of the centre was a swimming pool covered by glazed roof offering almost un-interrupted light to flood in.

In Finsbury,north London Russian émigré architect Berthold Lubetkin proclaimed that nothing was too good for the ordinary people. As part of the grand Finsbury Plan was an ambitious comprehensive health complex including public baths, nursery and library but sadly only the health centre, completed in 1937, was built. As well as treating their ailments, Lubetkin wanted to persuade people to live healthier lives. In contrast to the surrounding poverty, the interior was enriched in reds and azures with murals instructing visitors to take fresh air and exercise. The glass brick front elevations are symbols for the physical benefits of a light and airy environment. Aware that in years to come the changing technology of healthcare would require an adaptable building, Lubetkin designed the services with flexibility in mind. Post war the Pioneer Health Centre closed in 1950 due to re-occurring funding problems, unlike the more functionally explicit Finsbury Health Centre, which fitted more readily into the curative ethos of the newly formed NHS.

With a broad-brush uniformity little in the NHS would compare with the modernist prototypes at Peckham and Finsbury until the late eighties. During that decade when Nucleus was reaching its zenith and the health service dictate was in devolvement, one strand of which the phenomena of community hospitals would receive critical acclaim. With the Lambeth Community Care Centre, south London was once again in the vanguard bringing healthcare nearer to home.

Recently honoured by the Prince's Foundation for Integrated Medicine, patients at the Blackthorn Trust and Medical Centre in Maidstone can make appointments for art or music therapy, massage or counselling with in-house practitioners. They can join in the craft group or allotment gardening activities while the job searchers from the Owork-ways¹ project seek employment for those with longer-term illness. According to senior partner and founder Dr David McGavin: "It's about getting people to make changes so they are less dependant on the health and social services.3" Art therapist Hazel Adams, whose methods are based on anthroposophy, convinced McGavin to let her instruct suitable patients, with a range of difficult-to-treat complaints. They began painting and sculpting, then meeting in each other's homes after which the successful trial became permanent. The Blackthorn Trust was formed in 1985 so patients could receive therapy based on anthroposophical medicine established by Austrian philosopher Rudolf Steiner. It views illness not as a threat but as a challenge that can lead to self-development, with patients actively engaging in their own treatment and rehabilitation. The present building, neighbouring the renowned Nucleus hospital at Barming, opened in 1991 and was designed along the Steiner principles by Aberdeen based Campbell Architects. With its friendly and intimate domestic façade light floods through the airy bay windows and skylights. The double-height waiting space with its curved wall and stair offers views to the extensive Blackthorn garden nursery behind the Medical Centre.

The Bromley by Bow Healthy Living Centre in one of East London's most deprived wards is a model for inner-city regeneration and must surely inform the current LIFT trailblazers. To deal with the pressures of social exclusion and care the centre's philosophy is direct community action by inviting the help of local people to share the workload. Housed in a purpose-built £1.5m primary care and community centre reception building adjacent to 2,000 m2 of new and refurbished church buildings in the corner of a 1900 three acre recreation ground this arrangement offers a fresh form of community health-campus. The centre aims to promote good physical and mental health as a positive step towards helping people to get the most out of life. Its activities are cross-sectoral and can be classified around five main pillars: health, enterprise, learning, environment and arts. Designed by architects Wyatt MacLaren, the Bromley by Bow Healthy Living Centre was completed in 1997. Built from hand made bricks the main new building is approached through an eighteenth century stone arch, into a garden sanctuary with pond and fountain. The reception space provides a gallery for local artists and to encourage social interaction signs are at a minimum. An extension completed in 2002 includes a neighbourhood café providing space for training in food catering, arts and crafts studios, crèche and job club. The lead GP Sam Ethrington recommends "spending the money on a beautiful building in which local people feel ownership and pride. Build it twice the size you think you need and fill it with every local enterprise you can think off.4"

In Devon, Dr Paul Neilson and his colleagues went to considerable lengths to reach out to the local population in the newly opened Okehampton Centre for Health. Replacing the old Victorian hospital, the name is symbolic of a significant change in attitude towards the seamless service the GP's intend to provide. From now the emphasis is on health creation, a community based operation including homoeopathy and holistic therapies. Overall it has taken nine years in the making with three years to develop the brief and financial opportunity but with its butterfly clerestory window section and a caterpillar formation orientated for maximum sunlight, the outcome has been worthwhile. According to its designers Grainge Architects the key to the formal characteristics is a passion for humanity and the community of users.With a diligently considered functional plan and resistance to orthogonal room configurations the architects have extrapolated the wavy footprint to nest gently into the contour of the hillside. The day services are articulated through a series of consultation pods providing an undulating curved profile. Through its raised aromatic plant beds and pergola pathway the landscaping provides a further layer of protection for the approaching visitor. Encapsulated by the fully glazed circulationscreens the healing garden sanctuary within the main courtyard contains the strolling-garden by the contemporary Japanese landscape artist Tsutomu Kasai, sponsored by the Johrei Society. Although Okehampton is a moss gardenwith clear Japanese references, Kasai took particular pains to ensure that the landscape was achieved in the spirit of both the Japanese and Westerngarden traditions. It incorporates local materials on the theme of the river confluence found within the town. Johrei as a therapy aims to help balance mind,body and spirit. It integrates the emotional, physical and spiritual to tackle illness and restore health. Johrei is a form of therapeutic art,developed in Japan based on an understanding that our mind and spirit greatly influence our physical well-being,

It was Dr Dixon who introduced the Johrei Society to Okehampton. Currently at his Cullumpton practice he and his partners are embarking on the brief for an Integrated Centre for Health to include a ten-bed suite and a range of social and voluntary provision. Like Okehampton the intention is to provide a community partnership and complementary therapy but also gymnasium, dentist and opticians. With its nutritional guidance and its own culinary herb and organic vegetable garden for the long-term ill, it aims to become a In order for people to become more responsible for their own state of health they must first become far better informed partners on issues relating to their future well-being. As longer-term health predictions and medical awareness improves, it seems likely the future balance of an ageing society favours encouraging prevention and maintaining wellness across the community. Driven by passion, a spirited sense of commitment and ownership building health into the community has demonstrably illuminated the path and challenges ahead.

References 1 Health Defences by Dr Paul Clayton Accelerated Learning System

reprinted 2003 2 Positively Healthy by Lesley Hall, senior Assistant

Archivist Wellcome Trust Library 3 The Art of Self Healing by Anne Woodburn

The Times 14 May 2002 4 Primary Care NHS Magazine May 2002


Homepage    Health Design